Provider Demographics
NPI:1639709264
Name:MILLER, ALEXIS KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7991 CAIN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9630
Mailing Address - Country:US
Mailing Address - Phone:269-319-9417
Mailing Address - Fax:
Practice Address - Street 1:2820 BAKER RD STE 100
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1196
Practice Address - Country:US
Practice Address - Phone:269-319-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801104601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker